When a Simple Blue Light Was the Hot New Anaesthetic in Dentistry | Hacker News Reader

When a Simple Blue Light Was the Hot New Anaesthetic in Dentistry

paleofuture.com

49 pointsHooke60 comments

I started refusing local anaesthetic for dental procedures when I was teenager. I discovered the pain of the procedure itself (such as drilling a cavity) was the same, but I was spared the pain of the injection and lingering numbness afterwards. I was happy to leave my appointments alert and pain-free.

I imagine any color light or other type of distraction would provide the same results. It's not even a placebo effect, so much as the fact that a lot of these procedures are well within most people's pain tolerance and/or can be over in a minute.

I gladly went under general anaesthesia to have my wisdom teeth removed, however.

I never had any issues with local anesthesia and usually get some novocaine gel as a local anesthetic prior to the local anesthetic. Maybe it is effective for some while not for others, I have no other explaination. I’d let a dentist drill anything, no matter how small without anesthesia.

Infiltration techniques depend on the patient and, to some extent, the skill of the dentist. They're most common for single extractions and cavity prep, sometimes endodontics.

Nerve block techniques are more effective but also difficult for dentists to do properly, and some dentists have low success rates. There's no way to know a given dentist's success rate, but an oral surgeon has a lot more practice with nerve blocks.

Finally, some drugs have a very slow onset and patients aren't given enough time for the effect. You also don't usually get to choose the drug as a patient.

I had a cavity filled without local anesthesia as a poor backpacker in Thailand. It hurt. Not as bad as I thought it would, but I’ve never felt the need to turn down local since.

I also had my wisdom teeth out under local. The pain was bearable, but it is a much more violent procedure than I would have guessed. Given that general comes with a non-zero risk of death, I’d still do local again on that one. Plus it’s kind of a trip to watch someone wrench a tooth out of your mouth.

> I also had my wisdom teeth out under local.

Me too, but it makes a big difference how far erupted they are. Mine were basically half way out, and were starting to cause problems, so pull them all. The top ones came out with like one yank each, but the bottom ones took a lot of tugging. The dentist said that was pretty normal, top teeth are barely hanging on.

Mine were just beginning to come in and for some reason my dentist felt it was okay to remove them... trying to pull them was a joke, so he used a tiny reciprocating saw to cut each tooth into pieces. Took 3 hours, and given the amount of local used it would have been better to do general. Worst pain I ever felt was when the anesthetic wore off 30 minutes post procedure.

> for some reason my dentist felt it was okay to remove them

That reason is probably 'he stands to make a lot of money for getting to them before any other dentist'.

The funny thing is he had been my dentist for 3 years to that point, and because of this my family moved on to someone else. And there were potential repercussions beyond as my face was crazy swollen for a couple weeks and dozens of teachers/students wanted to know WTF happened... like if I was in a car wreck and broke my jaw or something.

I'm sure the local butcher would have costed you less.

Is general anesthesia then offered somewhere as an option for wisdom tooth removal? That sounds massively excessive for what usually is just pulling a teeth out.

In the US apparently. I'm German and I also found it completely wild when I heard it. Over here they give you barely anything if they fix a cavity and for wisdom teeth you get local anesthetics, and afterwards they tell you to take an ibuprofen and an ice pack when you have some pain. People in the States even told me they got opioids from a dentist.

GA isn't uncommon there for wisdom teeth removal, either, standard insurance just doesn't pay for it so it's reserved for privately insured people.

North-western Europe generally does a lot less for pain management than US and the rest of Europe. It's a big complaint of expats.

I've heard it explained as a cultural remnant "pain belongs with life, suck it up" from protestantism.

Well mother theresa wasn't big in anesthetics as well.

Can confirm re:opioids, the dentist prescribed Vicodin (acetaminophen + hydrocodone) post surgery. It seemed pretty excessive.

Yes very common actually. Getting your wisdom teeth extracted at ~16 is also extremely common - a sort of rite of passage.

> That sounds massively excessive for what usually is just pulling a teeth out.

So with above in mind, the wisdom teeth are typically still inside the jaw's bone at that age so extraction is a full on surgery at that point. Drilling through bone and then the tooth is not for the feint of heart - so that's why it's so common to do general.

It does raise the question. Should wisdom teeth be extracted so early when it's not truly necessary yet?

Personally, having lived abroad now where a large percentage of people around me still have their wisdom teeth - I've seen the pain and problems having wisdom teeth can have and how expensive it is if you do have a problem. Doesn't seem worth not extracting at a younger age when you have "more freedom".

That's how it works here indeed -- you get them pulled out when they are in the way or start causing problems. I didn't have any specific problems with them, mostly just annoying to clean and some were coming out in a bit weird angles.

I got mine out through my 20s and 30s, and they were all quite straightforward. Local anaesthesia, pull the tooth, done in 15 mins. And like the other commenter said, you're told to take some ibuprofen if you have pain afterwards.

I have them in my mouth. Never had a problem.

Of course I haven't gone to a dentist, because I'm sure they'd think they are indeed a problem.

iirc, the wisdom from long ago was getting your wisdom teeth out in a hospital would be covered by medical insurance, but not by the dentist. And general was part of that, but I don't know the timeliness or prevalence of that

some people have very strong (negative) reactions to having teeth pulled, my boss was out of work for days and swelled up like a chipmunk

It's not "just" pulling a tooth out. Depending on the case, it can become quite serious oral surgery.

Exactly. Depending on the location and "crookedness" of each tooth, the oral surgeon might grind down the inside of the jaw bone for a clean extraction.

Source: I've had three of my four wisdom teeth removed like that just a few weeks ago (mid thirties, local anesthetic). Chewing harder things like bread still hurts a little, otherwise it's fine.

For an uncomplicated case, I think the difference in risk between local and general is so tiny it cannot be reliably measured, when performed by competent pros in the western world.

The most reliable number I can find for patients without comorbidity is ~.4/100k[0] (so about 1/250,000). A study specific to dental anesthesia produced a similar number (3 per 1,000,000)[1].

I couldn't find any mortality numbers for local anesthesia, but it would pretty much require an allergic reaction, and I know from past experience I don't have that allergy.

So yes the increased risk for general is very low, but not unmeasurably so.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147285/ [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535496/

The sound effects were impressive.

I went under for my removal and I vaguely have a memory of waking up during one of the wrenching sessions, and the doctor saying something like “sorry, this one’s being a bit difficult, up his anaaaaaaaaa” and then I woke up at home in a comfy recliner.

> the pain of the procedure itself (such as drilling a cavity) was the same

I've not had cavities filled without anesthetic, but are you sure someone wasn't just fucking up the procedure? I've had plenty of dental work and if it's done properly it definitely isn't painful, just uncomfortable. I've definitely had cases where they didn't give me enough, and they've re-upped me and fixed the issue.

Same here for superficial cavities, I'd rather take milliseconds of pain over hours of numbness.

It's more than just the numbness: the actual numbing agent is often injected in combination with epinephrine (aka adrenaline), which acts as a vasoconstrictor and tends to keep the anesthetic in the right place longer... but some of that is eventually going to get into your overall bloodstream and the result is that you are now a bit anxious/nervous :/ refusing the injection (which I also started doing back about 10-15 years ago, when the mother of my at-the-time-girlfriend told me about her experiences doing that) also thereby leaves you chemically calmer (and likely thereby better able to deal with any pain that does result).

Similar here. I disliked the numbness and the fact that I can't eat food for few hours after the procedure, so I just go anaesthetic free now. I can definitely tell the difference. It is painful without, but it's just some pain. I am an adult, I can take it. And the fact that I can leave without any lingering effects is very nice. Would probably still go for anaestesia for harder procedures like root canal.

In the UK, I've never been told not to eat after local anesthesia, just to be careful with anything hot or sharp, because I won't be able to feel if something is burning or spiking me.

There shouldn't be any pain at all during local anaesthetic, but you'll still feel movement. The injection also shouldn't be particularly painful if done correctly; something like a mild pinch. They can use numbing gel prior to the injection if needed. It also shouldn't affect your alertness.

Are you perhaps a redhead or something else that would give you an atypical response to anaesthesia and pain? Some people do just need a higher dose of local anesthetic, and your dentist should provide it if you're still in pain.

If done correctly!

I was unlucky and it was extremely painful. It also resulted in a very minor permanent facial droop.

Is this some sort of self-hypnosis?

EDIT: And some searching reveals case studies of people with blue-tinted vision during relaxation exercises... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1318469/

EDIT 2: Weirdly down the rabbit-hole from that last article -- Viagra and blue-tinted vision. https://www.livescience.com/viagra-sildenafil-vision-changes...

The human brain is a bizarre thing.

Probably, of the form of 'focus on the light, rather than the pain', it probably works to some degree as most dental work pain, anaesthetic-less, isn't AS terrible as people imagine it will be - it's still bad, just bearable (I've had 2 teeth drilled without anaesthetic)

One of the best inventions in modern dentistry is the laser. The last time I had to have work done my dentist used one of those instead of a mechanical drill, it was really great. No novacaine, no pain, very fast. Quick composite filling and I was out of his office in perhaps 20 minutes for the whole visit. The only time he used a mechanical tool was when he was making sure the edges of the composite filling were perfectly flush.

> One of the best inventions in modern dentistry is the laser.

How about CEREC-type systems? No more alginate molds and long turnarounds; just scan the patient's mouth with a handheld instrument and mill out a ceramic prosthetic in the office.

The anesthetic doesn't always work for me, and I seem to need a lot if it is going to work.

Sometimes I can't be bothered to complain, since I know then we have to jab, and wait, and my face (but not always my tooth) will be numb for a really really long time.

I joke that I'm just building up resistance to physical torture, but it's like you describe. Pretty bad, but I just stare off into space and it's over soon.

When I had a major cavity filled—I don't remember the details—they essentially gave me as much anesthesia as they safely could, but something about the placement of the teeth or the nerves meant that the operation had to be very close to the nerve. They literally had to ask me if I could at least keep the screaming down to a level that it didn't scare the other patients. I'm very happy for people for whom it's not unbearable, but I think that's not a universal.

(My mom was resistant to anesthesia, which dentists generally didn't believe when told, so they'd try to distract her and drill when she wasn't expecting to prove that she was actually numbed. She wasn't, and it hurt so much and she built up so much distrust she simply wouldn't go to the dentist any more.)

Get FL-41 glasses or covers. They are drastically better than blue light glasses.

At one point if around phosphorescent, lights, I would get a severe headache in 10 minutes without anything. 20 minutes with bow light glasses, about 4 hours with FL-41.

I don't know, as a neuroscientist this is very confusing. Blue light generally is linked to arousal, as in this study for instance: https://pubmed.ncbi.nlm.nih.gov/32973462/

I wonder if there is some paradoxical effect if you put in a lot of blue light you get a decrease in arousal? Perhaps it could also be something like repetition suppression, where there is a lot of activity and arousal initially, but this causes a backlash and you get a relaxing effect?

Or maybe it's all just placebo.

This would explain why so many people were dazed and confused by the PC tower blue LED craze of the early 2000s.

I wouldn't claim dazed or confused for myself, but I _could_ read easily by them on my machines[1]. So I had make sure two were asleep, and the third…well, it thought it should blink a steady 1 Hz while in sleep. That one was also the brightest. There was no setting for the blink, so I had to unplug the LED to sleep.

[1] Not that everybody would agree. I've joked that I have Low-Light Vision.

16 candlepower just doesn't seem like a powerful light. That's around 1800 lumens if unfocused.

Sometimes I can distract myself with a computer screen and I don't notice chronic pains but I don't think it's the blue light doing it.

How many came back to have more teeth extracted under his magic blue light? None I would venture.

People were just afraid to tell him his treatment didn’t work. Same as what I see very often today, deference to the point the providers don’t have any real clue if their interventions are effective.

Some people can convince themselves that they feel no pain. I am one of those that self deceived myself into thinking that I felt no hip pain for years. Looking back I had ongoing pain yet if you asked me I would say no. I was not lying. I don't understand why but in my mind what I was feeling was not pain. It was just a bother.

I suspect that the blue light success stories were convinced that they should have no pain therefore they did not. It's all in the mind.

"Weaponized placebo" can be a powerful treatment method, though it shouldn't be the only method available.

Ezra Klein had a fascinating discussion on this topic a few months ago https://www.nytimes.com/2023/02/21/opinion/17eks-ezra-klein-...

Very interesting that according to the NHS wisdom teeth removal is seen as a last resource procedure https://www.nhs.uk/conditions/wisdom-tooth-removal/

while in USA seems to be "we do it to everybody because some of them might actually need it and the money is good"

I kept mine as a teenager, and regretted the problems they later caused until they had to be pulled 20 years later. As that teenager in the USA, my dentist told me it was optional. It wasn't until about 10 years later that the problems started.

As I wrote in a different comment: I kept mine as a teenager and they're still there and I'm fine.

My wife long ag had the misfortune to have dental work done by a dentist who believed in the analgesic properties of classical music, delivered over headphones. This had no effect on the pain. Marshall McLuhan mentions the technique in one of his books, perhaps The Gutenberg Galaxy, which may be a sign that he never tried it.

It's not crank stuff. I hate this common call of the old as "dumb crank shit!"

Near-infrared already known to have many beneficial effects, even just through the skin: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738953/

In addition, the brain does get electrical signals straight from the eyes that very much depend on the type of light. Acting as if this is all olden fluff is as dumb as acting as if it is a panacea.

> I hate this common call of the old as "dumb crank shit!"

I prefer it to the calls of the credulous and the scammers. Bleach is also known to have beneficial effects. Should we drink it?

https://www.logicallyfallacious.com/logicalfallacies/Appeal-...

Try actually debating instead of using cheap parlor tricks, as the "the scammers" would.

He's pointing out that just because near-infrared light on one end of the spectrum may have some beneficial effects on tissue, that it doesn't necessarily follow that using some light of pretty much the opposite color will reliably allow a dentist to yank out your tooth without pain.

Equating the two was the big logical fallacy here.

I challenge you to identify which logical fallacies -- from your own link -- in which you are engaging.

Seriously, you railed against this being called "dumb crank shit" -- and I have yet to see where it's actually being called anything close to that.

According to the Miracle Mineral Solution people, and I am unfortunately not making this up, we should.

Nobody at the time of your post, and including the article contents, called it dumb crank shit.

Maybe dial it back a bit?

The author implies it: "As I’ve written before, you couldn’t pay me any amount of money to go back in time and experience the horrors of dentistry before the most modern technology"

I don't have to doubt that the technological accomplishments of the past were marvels for their time to be glad that I don't have to relive them.

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